后路通道下行单边内固定术治疗腰椎间盘突出症临床研究

发布时间：2018-05-15 18:54

本文选题：单边内固定 + 腰椎间盘突出症　；参考：《承德医学院》2017年硕士论文

【摘要】：目的:探讨应用Mast quadrant可扩张通道系统行单边椎弓根钉内固定联合椎间Cage植骨融合术治疗腰椎间盘突出症的临床疗效。方法:针对我科2014年1月到2016年1月住院,行腰椎间盘切除、椎间Cage植入融合、椎弓根钉内固定手术的147例腰椎间盘突出症病人进行回顾性分析,其中应用Mast quadrant可扩张通道系统行单边内固定治疗的患者59例,平均随访20.39±4.45个月;采用传统开放TLIF行双边内固定治疗的患者88例,平均随访19.85±4.64个月。对比分析两组病人的一般资料、术后住院天数、手术时间、术中出血量、住院治疗费用、手术前后的疼痛视觉模拟评分(VAS)和日本骨科协会评估治疗(JOA)评分、植骨融合率、术后48h肌酸激酶(CK)升高值及并发症的发生情况。结果:(1)与双边内固定组比较,通道下单边内固定治疗的患者的手术时间明显缩短(P0.05),术中失血量明显减少(P0.05),单边组术后48h肌酸激酶(CK)升高值比双边组要低(P0.05)。(2)两组之间的术后住院时间、住院治疗费用比较差异均无统计学意义(P0.05);末次随访VAS、ODI、JOA评分以及植骨融合率比较差异均无统计学意义(P0.05)。结论:Mast quadrant可扩张通道系统下行单边内固定并椎间融合治疗单间隙腰椎间盘突出症与传统开放TLIF双边内固定的疗效相同,但通道下单边内固定具有手术创伤小、手术时间短、出血量少等优点,但手术适应症需严格控制。
[Abstract]:Objective: to investigate the clinical effect of unilateral pedicle screw fixation combined with intervertebral Cage fusion in the treatment of lumbar disc herniation with Mast quadrant extensible channel system. Methods: a retrospective analysis was performed on 147 patients with lumbar disc herniation who were hospitalized from January 2014 to January 2016, underwent lumbar discectomy, intervertebral Cage implantation and fusion, and pedicle screw fixation. 59 patients treated with unilateral internal fixation with Mast quadrant extensible channel system were followed up for an average of 20.39 卤4.45 months, and 88 patients with conventional open TLIF for bilateral internal fixation were followed up for an average of 19.85 卤4.64 months. The general data, postoperative hospitalization days, operative time, intraoperative bleeding volume, hospitalization cost, pain visual analogue score before and after operation (VAS) and Japanese Orthopedic Association (JOA) score, bone graft fusion rate, were compared and analyzed between the two groups. Creatine kinase (CK) increased at 48 h after operation and complications occurred. Results compared with bilateral internal fixation group, The operation time of patients treated with unilateral internal fixation under the channel was significantly shorter than that of the bilateral group, and the postoperative hospitalization time between the two groups was significantly lower than that in the bilateral group, and the blood loss during the operation was significantly reduced in the unilateral group, and the increase of creatine kinase (CK) in the unilateral group at 48 hours after operation was lower than that in the bilateral group. There was no significant difference in the cost of hospitalization (P 0.05), and there was no significant difference in the JOA score and bone graft fusion rate (P 0.05) during the last follow-up. Conclusion the effect of one-sided internal fixation and intervertebral fusion in the treatment of single-space lumbar disc herniation is the same as that of traditional open TLIF bilateral fixation, but the unilateral internal fixation under the channel has the advantages of minimal surgical trauma and short operative time. The amount of bleeding is low, but the indication of operation should be strictly controlled.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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